Kyle N Remick1, C William Schwab, Brian P Smith, Amir Monshizadeh, Patrick K Kim, Patrick M Reilly. 1. From the Department of Trauma and Acute Care Surgery, Walter Reed National Military Medical Center (K.N.R.), Bethesda, Maryland; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Hospital of the University of Pennsylvania (C.W.S., B.P.S., P.K.K., P.M.R.), Philadelphia; and Department of Surgery, Allegheny General Hospital (A.M.), Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Early trauma deaths have the potential for salvage with immediate surgery. We studied time from injury to death in this group to qualify characteristics and quantify time to the operating room, yielding the greatest opportunity for salvage. METHODS: The Pennsylvania Trauma Outcomes Study (PTOS) is a comprehensive registry including all Pennsylvania trauma centers. PTOS was queried for adult trauma patients from 1999 to 2010 dying within 4 hours of injury. The distribution of time to death (TD) was examined for subgroups according to mechanism of injury, hypotension (defined as systolic blood pressure ≤ 90 mm Hg), and operation required. The 5th percentile (TD5) and the 50th percentile (TD50) were calculated from the distributions and compared using the Mann-Whitney U-test. RESULTS: The PTOS yielded 6,547 deaths within 4 hours of injury. The overall TD5 and TD50 were 0:23 (hour:minute) and 0:59, respectively. Median penetrating injury times were significantly shorter than blunt injury times (TD5/TD50, 0:19/0:43 vs. 0:29/1:10). Median time was significantly shorter for hypotensive versus normotensive patients (TD5/TD50, 0:22/0:52 vs. 0:43/2:18). Operative subgroups had different TD5/TD50 (abdominal surgery [n = 607], 1:07/2:26; thoracic surgery [n = 756] 0:25/1:25; vascular surgery [n = 156], 0:35/2:15; and cranial surgery [n = 18], 1:20/2:42). CONCLUSION: Early trauma deaths have the potential for salvage with immediate surgery. We found TD to vary based on mechanism of injury, presence of hypotension, and type of surgery needed. With the use of TD5 and TD50 benchmarks in these subgroups, a trauma system may determine if decreased time to the operating room decreases mortality. Trauma systems can use these data to further improve prehospital and initial hospital phases of care for this subset of early death trauma patients. LEVEL OF EVIDENCE: Epidemiologic study, level III.
BACKGROUND: Early trauma deaths have the potential for salvage with immediate surgery. We studied time from injury to death in this group to qualify characteristics and quantify time to the operating room, yielding the greatest opportunity for salvage. METHODS: The Pennsylvania Trauma Outcomes Study (PTOS) is a comprehensive registry including all Pennsylvania trauma centers. PTOS was queried for adult traumapatients from 1999 to 2010 dying within 4 hours of injury. The distribution of time to death (TD) was examined for subgroups according to mechanism of injury, hypotension (defined as systolic blood pressure ≤ 90 mm Hg), and operation required. The 5th percentile (TD5) and the 50th percentile (TD50) were calculated from the distributions and compared using the Mann-Whitney U-test. RESULTS: The PTOS yielded 6,547 deaths within 4 hours of injury. The overall TD5 and TD50 were 0:23 (hour:minute) and 0:59, respectively. Median penetrating injury times were significantly shorter than blunt injury times (TD5/TD50, 0:19/0:43 vs. 0:29/1:10). Median time was significantly shorter for hypotensive versus normotensivepatients (TD5/TD50, 0:22/0:52 vs. 0:43/2:18). Operative subgroups had different TD5/TD50 (abdominal surgery [n = 607], 1:07/2:26; thoracic surgery [n = 756] 0:25/1:25; vascular surgery [n = 156], 0:35/2:15; and cranial surgery [n = 18], 1:20/2:42). CONCLUSION: Early trauma deaths have the potential for salvage with immediate surgery. We found TD to vary based on mechanism of injury, presence of hypotension, and type of surgery needed. With the use of TD5 and TD50 benchmarks in these subgroups, a trauma system may determine if decreased time to the operating room decreases mortality. Trauma systems can use these data to further improve prehospital and initial hospital phases of care for this subset of early death traumapatients. LEVEL OF EVIDENCE: Epidemiologic study, level III.
Authors: Juan C Mira; Benjamin E Szpila; Dina C Nacionales; Maria-Cecilia Lopez; Lori F Gentile; Brittany J Mathias; Erin L Vanzant; Ricardo Ungaro; David Holden; Martin D Rosenthal; Jaimar Rincon; Patrick T Verdugo; Shawn D Larson; Frederick A Moore; Scott C Brakenridge; Alicia M Mohr; Henry V Baker; Lyle L Moldawer; Philip A Efron Journal: Physiol Genomics Date: 2015-11-17 Impact factor: 3.107
Authors: Michael A Vella; Ryan Peter Dumas; Joseph DuBose; Jonathan Morrison; Thomas Scalea; Laura Moore; Jeanette Podbielski; Kenji Inaba; Alice Piccinini; David S Kauvar; Valorie L Baggenstoss; Chance Spalding; Charles Fox; Ernest E Moore; Jeremy W Cannon Journal: Trauma Surg Acute Care Open Date: 2019-11-11